Each year in the U.S. more than 200,000 youths are injured on the job and at least 70 are killed. In 1996, young workers were recognized as a Special Population and a national occupational research priority. The Massachusetts Department of Public Health (MDPH) has likewise identified the prevention of occupational injuries to youth as a public health priority. In 1992, MDPH passed regulations requiring physicians and hospitals to report occupational injuries to youth less than 18-years-old. Since that time, MDPH has worked, with support from NIOSH, to establish a model, comprehensive surveillance and intervention system for occupational injuries to youth. Multiple data sources including workers' compensation records, emergency department (ED) reports, and hospital discharge data are used for case ascertainment, follow-up interviews with injured teens are conducted, and surveillance findings are used to target work site interventions and broad-based prevention activities. MDPH proposes to continue and enhance the Massachusetts Surveillance System for Occupational Injuries to Youth and as a new initiative, to provide guidance to other states in implementing the model. Specific aims of this proposal are to: (1) Maintain and enhance case ascertainment using multiple data sources to identify sentinel cases and generate meaningful summary data; (2) Conduct timely follow-up interviews with injured youth in order to fully characterize the cases and target work site interventions; (3) Plan, conduct and foster intervention and prevention activities to reduce the risk of occupational injuries to youths in targeted workplaces, industries, and communities; (4) Analyze and disseminate surveillance data to promote prevention activities and to continue ongoing evaluation of the surveillance system; (5) Maintain and enhance collaboration between relevant government agencies and among public health practitioners in Massachusetts; and (6) Provide guidance to other states in implementing the model. Proposed enhancements of the model include: (a) expanding the number of EDs reporting cases to obtain a statewide representative sample of EDs; (b) evaluating use of alternative sources of state employment data in calculating occupational injury rates; (c) piloting the use of self-administered follow-up questionnaires to increase follow-up capacity; and (d) refining and documenting protocols for conducting research oriented workplace investigations of non-fatal incidents and disseminating incident reports. MDPH will also obtain input from states in the northeast and produce a "how-to" guide for surveillance of work-related injuries to youth that may be used by other states across the country.